Ivan A. Casas

Treatment of diarrhea

To the Editor.— The report on antidiarrheal agents by Portnoy et al (236: 844, 1976) confirms a previous report on the lack of efficacy of kaolin in the treatment of cholera. 1 If there is any rational role for kaolin, it is perhaps as a placebo alternative to be given for mild, self-limited diarrheas in place of antibiotics. For most such diarrheal episodes, antibiotics are of little value, and their indiscriminate use may foster the emergence of resistant strains of pathogens. In cases of more severe diarrhea in which antibiotic therapy is needed for a specific pathogen, it is important to avoid simultaneous therapy with antidiarrheal remedies that may adsorb the antibiotic, thus prolonging the diarrhea. One such agent is activated charcoal. 2 While kaolin did not appear to prolong cholera diarrhea when tetracycline was given concomitantly, it has not been tested clinically in conjunction with other antibiotics. It is possible